Outcomes of a nurse-led model of care for hepatitis C assessment and treatment with direct-acting antivirals in the custodial setting

Background: People in prison have been identified as an important population to prioritise for hepatitis C virus (HCV) treatment to achieve HCV elimination goals. We evaluated the efficacy of the New South Wales Justice Health and Forensic Mental Health Network Hepatitis Nurse Led Model of Care during the 12 months following the widespread availability of HCV direct acting antivirals (DAAs) in Australia. Methods: A retrospective cohort study was conducted of a network of 36 correctional centres across NSW from April 2016 to March 2017, with approximately 13 000 full time inmates. Population Health Nurses conducted initial clinical assessments and confirmatory testing. Patients were referred to a Hepatitis Clinical Nurse Consultant (CNC) for protocol-driven assessment, including transient elastography to assess hepatic fibrosis. The CNC then discussed the case with an Infectious Diseases physician and DAA therapies were prescribed. The total number of patients who commenced and completed treatment, and sustained virological response 12 weeks post treatment completion (SVR 12) were recorded. Results: During the first 12 months of DAA treatment 698 patients were commenced on HCV treatment. Of those who were tested at the 12-week post treatment completion timepoint the per-protocol SVR12 (cure) rate was 92% (396/430), with 34 patients having a detectable viral load. 52 (7%) patients were released to freedom before completing treatment and a further 211 (30%) were released prior to SVR12 assessment. These outcomes indicate an intention-to-treat SVR 12 cure rate of 57% (396/698). There were no differences in demographic or treatment characteristics between those who underwent SVR12 testing and those released prior. Conclusions: Treatment for HCV can be delivered safely, efficiently and in high numbers in the prison setting using a nurse-led model of care. This will be an important component of the strategy to eliminate HCV infection as a public health concern by 2030.